Trends in Lung Cancer Incidence -- United States, 1973-1986

In 1973, the National Cancer Institute (NCI) initiated a
population-based tumor registry reporting system for cancer
incidence
and survival. This system, the Surveillance, Epidemiology, and End
Results (SEER) Program, receives reports from five states and four
metropolitan areas* representing approximately 10% of the U.S.
population. SEER data are used to assess the health burden of
cancer,
identify populations at increased risk, and measure the impact of
cancer prevention and control efforts. This report describes trends
in
the incidence of cancer of the lung and bronchus during 1973-1986
based
on the International Classification of Diseases for Oncology
(ICD-O)
categories 162.2-162.9 (1). Rates are age-adjusted by the direct
method
to the 1970 U.S. population.

From 1973 through 1986 (2), lung cancer incidence (Figure 1, page
511)
increased for all race/sex groups except white males. Among white
males, the incidence of lung cancer decreased for 2 consecutive
years
to 80.3 per 100,000 in 1986 (Table 1, page 511), the lowest level
since
1977. Incidence rates in 1986 varied substantially by sex and race,
with rates for white males (80.3) double those of white females
(37.0)
and rates for black males (128.1) triple those of black females
(43.0).
Incidence for black males was 60% higher than that for white males;
in
contrast, rates were similar for black females and white females.

Although overall incidence for males (range: 73.3-86.5) remained
substantially higher than that for females (range: 18.3-36.4)
during
1973-1986, the trend for males increased at an average of 1%-2% per
year, compared with an average increase of 5%-6% for females.
During
1982-1986, however, the annual rate of increase for white females
was
2%, compared with greater than 8% for black females (Figure 1,
Table
1).

The SEER Program also collects morphologic information (3) on each
primary site according to ICD-O (Table 2). The histologic
distributions
among different sex/race groups suggest different exposure patterns
in
the occurrence of lung cancer. For example, squamous-cell
carcinoma--the histologic type most commonly associated with
smoking--is more prevalent in males than females.
Reported by: LA Gloeckler Ries, MS, BK Edwards, PhD, EJ Sondik,
PhD,
Surveillance Program, and Smoking, Tobacco, and Cancer Program, Div
of
Cancer Prevention and Control, National Cancer Institute. Office on
Smoking and Health, Center for Chronic Disease Prevention and
Health
Promotion, CDC.

Editorial Note

Editorial Note:

The peak exposure (per capita consumption) to tobacco among men
occurred before 1952, whereas peak exposure among women occurred in
the
1960s. Peak incidence and mortality rates due to lung cancer lag
behind
the peak exposure to tobacco by approximately 35 years (4). Because
of
a substantial recent decline in smoking prevalence among men (from
50.2% in 1965 to 31.7% in 1987) the rise in the age-adjusted death
rate
of lung cancer for men began to level off in the late 1970s. In
comparison, the later peak exposure and the slower decline in
prevalence among women between 1965 and 1987 (31.9% to 26.8%) has
caused the age-adjusted lung cancer death rate among women to
continue
to climb. Lung cancer has surpassed breast cancer as the most
common
cause of cancer death among women (5).

Although almost half of all Americans who ever smoked have quit,
greater than 50 million persons continue to smoke (6). The burden
of
lung cancer and other smoking-related chronic diseases will be
substantially higher for eversmokers for many decades because of
the
long latency periods between exposure to tobacco and onset of these
diseases. To reduce the incidence and mortality of smoking-related
diseases, major public health interventions against smoking are
necessary.

NCI has initiated two large-scale research and demonstration
programs
that are designed to help reduce the prevalence of smoking and
ultimately lower cancer incidence and associated mortality. Both
programs are part of the NCI Smoking, Tobacco, and Cancer Program,
which is the focal point for NCI's research, disease prevention,
and
health promotion activities related to tobacco use and cancer.

One program, the Community Intervention Trial for Smoking
Cessation
(COMMIT), is evaluating a community-based intervention protocol in
11
communities in North America. Implemented in 1986 and scheduled to
run
through 1995, COMMIT is focusing on heavy smokers (greater than or
equal to 25 cigarettes per day), a group that represents 27% of all
smokers and accounts for nearly 50% of lung and other cancers among
smokers. The COMMIT protocol employs the most promising
interventions
offered through physicians and dentists, the media, worksites,
community organizations, schools, and cessation providers.

A second program, the American Stop Smoking Intervention Study
(ASSIST), will use the results, materials, and protocols developed
by
COMMIT and other intervention studies to prevent or reduce smoking
in
20 U.S. areas (either entire states or large metropolitan areas)
involving nearly 50 million Americans. ASSIST will begin in 1993
and
continue for 5 years in cooperation with the American Cancer
Society
(ACS). NCI funding will be awarded to various state and local
health
departments, which will work with ACS to form local coalitions.
Interventions will be implemented through the health-care system;
worksites; schools; civic, social, and religious organizations; the
media; and existing state and local smoking policies. The goal of
ASSIST will be to reduce smoking prevalence by nearly 50% in all 20
intervention areas by 1998.

References

World Health Organization. International classification of
diseases
for oncology. 1st ed. Geneva: World Health Organization, 1976.

National Cancer Institute. Cancer statistics review 1973-1986,
including a report on the status of cancer control. Bethesda,
Maryland:
US Department of Health and Human Services, Public Health Service,
National Institutes of Health, 1989; NIH publication no. 89-2789.

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